1871510859 NPI number — FERRIS STATE UNIVERSITY

Table of content: (NPI 1871510859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871510859 NPI number — FERRIS STATE UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FERRIS STATE UNIVERSITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UNIVERSITY EYE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871510859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1124 S STATE
Provider Second Line Business Mailing Address:
101 H.
Provider Business Mailing Address City Name:
BIG RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-591-2020
Provider Business Mailing Address Fax Number:
231-591-3991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1124 S STATE
Provider Second Line Business Practice Location Address:
101 H
Provider Business Practice Location Address City Name:
BIG RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-591-2020
Provider Business Practice Location Address Fax Number:
231-591-3991
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OSOSKI
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICAL RECORDS/INSURANCE SPECIALIS
Authorized Official Telephone Number:
231-591-3056

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 180E410080 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 999998001 . This is a "VSP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 900E47602 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 900E476020 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0M41110 . This is a "MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 900006367 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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